NPIMap

Organization Active NPI

Kidzcare Pediatrics, PC

  • Pediatrics Physician
  • Williamston, NC
National Provider Identifier
1124627146
Registry record updated Oct 31, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatrics PhysicianTaxonomy code 208000000X
Legal business name
KIDZCARE PEDIATRICS, PC
Practice address
413 W Main St
Williamston, NC 27892-2319
Phone
(252) 792-4410
NPI assigned
Oct 21, 2020
Last updated
Oct 31, 2022By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 31, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Shantae Renee Lockhart
Title
Credentialing Admin
Phone
(910) 483-7337

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics Physician 208000000X NU Primary

Addresses

Primary practice location

413 W Main St
Williamston, NC 27892-2319

Mailing address

PO Box 9219
Fayetteville, NC 28311-9082
Phone (910) 483-7337

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
34D0242323Kidzcare Pediatrics PC413 W. Main Street, Williamston, NC 27892Certificate of waiverNov 29, 2026

National Provider Directory

National Provider Directory
Tax ID family
Kidzcare Pediatrics PC28 organizations share this tax ID, including this one

Other organizations with this tax ID 27

Organizations that report the same tax identification number in the National Provider Directory.

View all 27

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1603238400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1667174400000",
    "number": "1124627146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 9219",
            "city": "FAYETTEVILLE",
            "state": "NC",
            "postal_code": "283119082",
            "telephone_number": "910-483-7337",
            "fax_number": "910-483-0648"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 W MAIN ST",
            "city": "WILLIAMSTON",
            "state": "NC",
            "postal_code": "278922319",
            "telephone_number": "252-792-4410"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KIDZCARE PEDIATRICS, PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-21",
        "last_updated": "2022-10-31",
        "certification_date": "2022-10-31",
        "status": "A",
        "authorized_official_last_name": "LOCKHART",
        "authorized_official_first_name": "SHANTAE",
        "authorized_official_middle_name": "RENEE",
        "authorized_official_title_or_position": "CREDENTIALING ADMIN",
        "authorized_official_telephone_number": "910-483-7337"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Williamston, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 31, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.